Early Stem Cell Transplant May Benefit Some Non-Hodgkin's Lymphoma Patients

THURSDAY, Oct. 31 (HealthDay News) -- Early stem cell
transplants do not improve overall survival in high-risk patients
with aggressive non-Hodgkin's lymphoma, but may be beneficial for a
small group of patients with the very highest risk, according to a
new study.

Non-Hodgkin's lymphoma is cancer of the white blood cells
(lymphocytes). Larger-than-normal lymph nodes and fever are common
symptoms.

Many patients with this type of cancer relapse after undergoing
chemotherapy and require an autologous stem cell transplant. In
that procedure, the patient's own stem cells are removed before
they receive high-dose chemotherapy and/or radiation. After the
chemotherapy, the patient's stem cells are returned to help
replenish the body's supply of blood cells.

This study of 397 patients in the United States and Canada
looked at whether giving patients a stem cell transplant before
they relapsed would improve their chances of survival. The
patients, who had an intermediate-high or high risk of relapse,
were randomly assigned to receive an early stem cell transplant or
to a "control group" that received three additional cycles of a
five-drug chemotherapy regimen.

After two years, 69 percent of those in the early transplant
group had no disease progression, compared with 55 percent of those
in the control group. However, both groups had similar survival
rates: 74 percent in the early transplant group and 71 percent in
the control group, the study found.

This is probably because patients in the control group who
relapsed were later offered stem cell transplants, according to Dr.
Patrick Stiff, director of Loyola University Medical Center's
Cardinal Bernardin Cancer Center, and colleagues.

Stem cell transplantation did not improve overall survival among
the entire group of high-risk and high-intermediate risk patients,
the study authors noted in a Loyola news release. However, it did
appear to benefit a subgroup of high-risk patients. Among these
patients, the two-year survival rate was 82 percent in the
transplantation group and 64 percent in the control group,
according to the report published Oct. 31 in the
New England Journal of Medicine.

"Early transplantation and late transplantation appear to be roughly equivalent approaches in the treatment of the combined risk groups," the researchers concluded. However, "early transplantation appears to be beneficial for the small group of patients presenting with high-risk disease," the authors added.

It's hoped that the findings "will trigger discussions between
such patients and their physicians as to the feasibility of doing
early transplants," Stiff said in the news release.

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